1. Quality Management Report for CCPC 2014-15 Pamela Casey-Lewis, MS, RD June 24, 2015

3. HRSA National Monitoring Standards Agency Expectations: Participate in Quality Management activities Compliance with HRSA service category definitions and local standards of care Collection and entering data for use in measuring performance

4. Objectives To utilize the data from the chart review to track the performance of Ryan White core services To identify any areas for improvement To provide the CCPC with the information needed to make funding decisions during the priority setting and resource allocation

5. The process Chart tool revised Access database updated Abstractors hired Scheduled during the last quarter Data collected and analyzed Data input and compilation

6. Review of Core Service Categories Ambulatory care Medical case management Oral health services Home and community-based health services Mental health services Substance use services Early Intervention Services (EIS)

7. Ambulatory Care 4 agencies

8. Demographics

9. At least 2 HIV provider visits during the period

10. Documentation of Primary Care in the last 6 months

11. Elements of the Treatment Cascade

12. Hepatitis-C Status Documented

13. Other Measures

14. Highlights Looking good – Prescribed ARV – VL suppression – Documentation of Hep-C status Areas for improvement – Document the dental care

15. Case Management 8 sites 125 charts

16. Demographics

18. HRSA MCM performance measures

19. Visits per 12 month period

20. Measures

21. Screening for other needs

22. Budgeting, life skills and self-sufficiency

23. Re-scheduling appointments

24. Highlights Looking good – Discussing self-sufficiency – Social service assessments – Risk reduction – Partner disclosure There is an increase in MCM clients being seen for 6 or more times per year.

25. Substance Use 4 sites 38 charts

26. Demographics

27. Care and Treatment

28. Retention in care

29. Highlights Drop in retention in care from 3 months to 6 months, but less of a drop than in the previous year Improvement in discussion around medication adherence

30. Mental Health 5 sites 55 charts

31. Demographics

32. Care and Treatment

33. Other assessments

34. Highlights Improvement in documentation of risk reduction, HIV medication adherence slight increase in retention at three months An increase in re-scheduled visits

35. Oral Health 6 sites 87charts

36. Demographics

37. HRSA Performance Measures for Oral health

38. Assessment and Retention

39. Highlights Improvement in all HRSA performance measures Attempts to retain clients in care

40. Home Health 1 site 15 charts

41. Demographics

42. Performance measures

43. Early Intervention Services 1 site 15 charts

44. Demographics

45. Performance Measures

46. Assessment for client needs

47. Highlights Younger population Less than half were previously linked to care Comprehensive assessments

48. Evaluation of the Chart Review Good: Helpful staff Separate private, space provided Flexibility with arranging extra time Needs improvement: Accessibility of data from EHRs Client list pulled from ARIES Looking to the future: Review data more often Use different contractors

49. Patient Satisfaction Boxes placed at several different agencies Partial collection (77) 49 Happy Just okay unhappy

50. Demographics 50

51. More demographics 51

52. The amount of time it takes to get an appointment 52

53. How does Staff treat you over the phone? 53

54. How does staff treat you while face-to-face? 54

55. The way your provider explains health-related information 55

56. The way your medical provider explains information to you 56

57. How is your privacy is handled? 57

58. How happy are you with the way your concerns/complaints are addressed? 58

59. Do you have a complaint that you are afraid to discuss with the staff? 59

60. The complaints No return phone call Incorrect medical information in file 60

61. How happy are you about the cleanliness at the site? 61

62. What helps you stay in care? 62

63. Others reasons listed… Talking to my mental health therapist Prescriptions are delivered at no additional charge Everybody is professional and friendly Getting fresh produce My case manager helped lift my spirits 63

64. What helps you stay connected to care?

65. Other comments It’s my responsibility to make appointments The staff is phenomenal I have a very good doctor Para transit vouchers

66. What are some reasons you’ve been out of care? 66

67. If you were out of care for 6 months, name the reason

68. Other reasons Didn’t have the money Depression Homeless Personal issues No transportation Sick Didn’t have insurance

69. How happy are you about recommending this site to other HIV+ clients? 69

70. Future Client Survey Distribution Increase responses by cross-part collaboration – using peers to promote the survey and to help clients complete it – Consider distributing the surveys at HIV support groups – Make even shorter Make the survey category-specific Make it available on-line 70